An in-depth analysis of 2016 U.S. drug overdose data shows that America’s overdose epidemic is spreading geographically and increasing across demographic groups. The report, from researchers at the Centers for Disease Control and Prevention (CDC), appears in the latest issue of MMWR.

Drug overdoses killed 63,632 Americans in 2016. Nearly two-thirds of these deaths (66%) involved a prescription or illicit opioid. Overdose deaths increased in all categories of drugs examined for men and women, people ages 15 and older, all races and ethnicities, and across all levels of urbanization.

CDC’s new analysis confirms that recent increases in drug overdose deaths are driven by continued sharp increases in deaths involving synthetic opioids other than methadone, such as illicitly manufactured fentanyl (IMF).

“No area of the United States is exempt from this epidemic—we all know a friend, family member, or loved one devastated by opioids,” said CDC Principal Deputy Director Anne Schuchat, M.D. “All branches of the federal government are working together to reduce the availability of illicit drugs, prevent deaths from overdoses, treat people with substance-use disorders, and prevent people from starting using drugs in the first place.”

CDC’s analysis, based on 2015-2016 data from 31 states and Washington, D.C., showed:

Across demographic categories, the largest increase in opioid overdose death rates was in males between the ages of 25-44.

Overall drug overdose death rates increased by 21.5 percent.

The overdose death rate from synthetic opioids (other than methadone) more than doubled, likely driven by illicitly manufactured fentanyl (IMF).

The prescription opioid-related overdose death rate increased by 10.6 percent.

The heroin-related overdose death rate increased by 19.5 percent.

The cocaine-related overdose death rate increased by 52.4 percent.

The psychostimulant-related overdose death rate increased by 33.3 percent.

IMF is mixed into counterfeit opioid and benzodiazepine pills, heroin, and cocaine, likely contributing to increases in overdoses involving these other substances.

Overdose death rates differ by state

Opioid death rates differed across the states examined in this study:

Death rates from overdoses involving synthetic opioids increased in 21 states, with 10 states doubling their rates from 2015 to 2016.

New Hampshire, West Virginia, and Massachusetts had the highest death rates from synthetic opioids.

Fourteen states had significant increases in death rates involving heroin, with Washington D.C., West Virginia, and Ohio having the highest rates.

Eight states had significant increases in death rates involving prescription opioids. West Virginia, Maryland, Maine, and Utah had the highest rates.

Sixteen states had significant increases in death rates involving cocaine, with Washington D.C., Rhode Island, and Ohio having the highest rates.

Fourteen states had significant increases in death rates involving psychostimulants; the highest death rates occurred primarily in the Midwest and Western regions.

“Effective, synchronized programs to prevent drug overdoses will require coordination of law enforcement, first responders, mental health/substance-abuse providers, public health agencies, and community partners,” said the report’s lead author, Puja Seth, Ph.D.

How to coordinate the public-health and public-safety response to overdose deaths

Today’s report highlights the continued need for public health and law enforcement to work together in preventing overdose deaths and taking action to:

CDC’s Overdose Prevention in States initiatives include funding for state-level public health efforts in 45 states and Washington, D.C., to implement key prescription and illicit opioid surveillance and prevention activities. CDC equips states with resources to prevent opioid misuse and overdose by tracking and monitoring the epidemic, helping scale up effective programs, and equipping health care providers with tools and guidance needed to make informed clinical decisions.